Digital health: seeing the forest and the trees

Forest at eye level

Originally presented at HLTH 2021

By Dave Neuman |
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HLTH Tech Talk transcript

Slide 1 (Introduction)

Thank you for coming to the 4:05 Tech Talk session.

My name is Dave Neuman. I’m the chief technology officer for Milliman HealthIO.

We’re on a mission to curb the rising risks and costs of chronic conditions for our clients and help individuals along their journey to stay healthy longer and minimize the effects of chronic conditions.

We’ve all worked with people who get caught in the details. Many times we will say, “they can’t see the forest from the trees.” They get lost amongst the data and the challenges of today and lose sight of the bigger context.

I like to use that as the basis for this presentation because I think many times when we talk about chronic condition management and trying to affect population health, we get lost in the details and forget the higher level context.

Slide 2

So let me start with a little visual.

Imagine you’re on a nature walk. You might even be an arborist or a nature fanatic. You look at these trees and they all look healthy. You don’t see any issues, but the forestry department who is managing that public park knows something you don’t know.

Slide 3

They know that there’s sickness amongst the forest. They have a different perspective than those that are on the ground. They also have a different job. Their job is to look out for the betterment of the forest as a whole and call in the experts when sickness needs to be eradicated.

Have we heard that before?

Slide 4

We transition that metaphor to regular life.

We have populations. We’re all part of different populations.

It could be a population of employees at work for a self insured employer. It could be a member of a health plan. Or I could be a life insurance carrier with a population of members.

Within each population, we’ve seen the statistics. The numbers are staggering of how many are living with and dealing with chronic conditions. Being able to identify who has a chronic condition is the first step at being able to help them mitigate and even control and minimize the impact or the progression of those diseases.

Those diseases may include hypertension, diabetes, COPD, obesity. The list goes on and on.

Slide 5

However, once we identify who has a condition, we typically talk about interventions. We talk about getting them on a program. Providers will prescribe medication.

What about those that don’t have a chronic condition? They should be put into a prevention program if they are healthy or they are below the set norms of disease.

How are we helping them maintain that level? That’s the challenge we have in curbing the onslaught of chronic conditions.

Slide 6

Digital health empowers everyone. Organizations, individuals…look around. There’s solutions, there’s technologies, there’s services all over. There’s a lot of smart people developing new solutions every day.

For organizations, we’re helping them identify risk. Identify and manage the unknown.

What’s going to be coming up next? What is going to be the cost of healthcare for my organization as a self- insured employer in the future?

Is it a 10% increase? Is it a 25% increase? That may be millions of dollars on my bottom line.

So helping them plan for the future is important. And engaging and empowering their workforce and wellness and health programs is important.

Flipping to the individual side, empowering individuals with the ability to collect data on their own, to interpret that data and see what it means for them in an individualized context.

Who knows? The technologies are there today to potentially predict and alert to an impending event coming up.

Slide 7

So how do we do this? At Milliman HealthIO we developed a digital solution that combines population health intelligence and chronic condition management in an easy to use, mobile-first digital environment.

We’ll take those that are healthy, not managing a chronic disease, and we will enroll them in a program.

We provide them a kit of Bluetooth-enabled devices, blood pressure cuff, weight scale, glucometer, etc., along with a mobile app, to collect and check in on their vitals at home on an ongoing basis.

We allow them to connect to friends and family through an advocacy network.

Predictive analytics, algorithms run in the background to predict the rising risk and impending health events coming up in the future.

Those trends can generate alerts and notifications that can then be forwarded on through their advocacy network or to providers and caregivers as needed.

Slide 8

From a chronic care management standpoint, the capabilities to manage a condition aren’t that different than prevention.

Once they are enrolled in the program, we allow them to check in and measure their vitals, track their medication, check in, and wellness parameters.

The biggest difference between prevention and chronic condition management is the protocol. It’s going to be tighter, it’s going to be more frequent check-ins. The analytics will be dialed in a little bit more specific to controlling a set condition.

Support network is even more important.

If an individual continues to be challenged to keep their diabetes under control, they continue to eat poorly or not exercise or adhere to their program, their sugar levels are going to continue to spike.

We need to alert others that surround them to give them the support they need on a daily basis. It doesn’t require going back to a provider. It’s someone close to them that can help them manage that condition better.

Algorithms, trend analysis, statistical process control, all these fancy terms can give a provider, care organization, better insight into the challenges an individual is facing on a day- to-day basis with their condition.

It isn’t a set-and-forget scenario. This is a set and remember and check in frequently scenario.

Slide 9

Data. Digital Health Tools. Integration, interoperability enables a whole new level of population health intelligence.

Deploying digital health tools into a population, collecting real time data from at home, provides organizations real-time visibility to current state of health.

We’re no longer waiting for a three month delay and claims data through a TPA to be able to do some kind of risk analysis.

We’ve got data today. We can see the change in the organization every day. We can monitor for risk at a population level. We can understand whether population health initiatives that we have deployed are working or not.

Is weight and obesity changing within the organization, or is that program not working effectively?

Adherence is critical to managing chronic conditions. Because we’re using tools to track day-to-day, we get adherence information. We understand the risk of not adhering to protocols and its effect on the effectiveness of those programs that are being deployed.

Engagement. I’ve heard a number of sessions here talk about patient engagement as being one of the biggest challenges.

Again, digital health tools, personal assistants in your pocket, devices that are used on a daily, weekly, monthly basis, gives us very in-depth engagement information related to health.

Slide 10 (Closing)

As a result, Milliman HealthIO is combining the power of population health with digital solutions for chronic condition management at home and providing a new set of tools for, as an ode to Bob Ross, creating “happy little trees” within our populations.

Thank you for your time and enjoy the rest of the conference.

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Smart guide to improving the outcomes of a wellness program

Man surrounded by data

With various types of wellness programs available, it can be challenging to provide employees with a program that works. What does a “working” wellness program look like? First and foremost, a wellness program should result in participants experiencing better health outcomes. And with better health outcomes, healthcare costs may drop—both for the company and its employees.

Once the program goals are clear, you’ll need to measure outcomes. Our suggestion? Add a digital health component. When employees are equipped with digital health tools, they can easily record, monitor, and analyze progress toward their health goals.

Digital health for wellness programs
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The benefits of longitudinal data

Collecting and analyzing data over time can benefit patients, providers, and population health

Data is one of the best tools to aid in the fight against chronic disease. Six out of ten American adults live with a chronic disease[1], making it imperative to analyze the health data of this population in order to help them achieve better outcomes.  This is where various types of data collected over time, also known as longitudinal data, can make a meaningful difference.

Using a digital health solution can enable at-risk populations to track their health vitals at home. Tracking vitals at home not only enables people to take control of their own health outside of the clinic, it can also give providers better insight into their patients’ health. When more health data becomes available to providers, they can make better decisions for not just their patients but for larger populations.

Milliman HealthIO longitudinal data infographic

[1] Chronic diseases in America. (2021, January 12). Retrieved November 17, 2021, from https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm

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The business case for resilience in the workplace

How digital employee health and wellness programs can address productivity

 

On average, Americans will spend 13 years and two months of their lives at work.[1] During that time, employers influence everything from professional development to the health and well-being of their employees. In today’s hypercompetitive business environment, employers can benefit from dedicating resources to nurturing resilience in the workplace.

What is resilience and why does it matter?

Resilience is a person’s ability to bounce back and recover quickly from adversity. Almost everyone experiences misfortune at some point during their career. Whether that hardship comes in direct relation to work or from outside factors (the current pandemic is a great example), the results can be costly to both employee and employer.

Loss in productivity

Absenteeism and presenteeism have serious costs for businesses.

In a research report published by the Centers for Disease Control and Prevention (CDC), the authors studied absenteeism due to chronic diseases (hypertension and diabetes) and unhealthy behaviors (smoking, physical inactivity, and obesity).[2] The results were sobering.

Absenteeism estimates ranged from 1 to 2 days per individual per year depending on the risk factor or chronic disease… Absenteeism increased with the number of risk factors or diseases reported. Nationally, each risk factor or disease was associated with annual absenteeism costs greater than $2 billion. Absenteeism costs ranged from $16 to $81 (small employer) and $17 to $286 (large employer) per employee per year.

Presenteeism refers to employees who are physically at work but, due to illness or medical conditions, are unable to fully perform their duties. According to a recent study produced by the Integrated Benefits Institute, “Employees covered for sick time, workers’ compensation, disability, and family and medical leave benefits are absent about 978 million days due to illness and incur an estimated 540 million lost work days due to presenteeism…”[3]

Employee turnover

Losing employees can be just as devastating as absenteeism and presenteeism. Productivity can take a hit, as other team members are tasked to cover a former colleague’s work as well as their own. Finding a replacement who can get up to speed quickly can be equally challenging, with one survey reporting that one-third of new hires fail to meet productivity targets.[4]

Turnover can also impact morale, creating a climate where the remaining workforce is stressed, unhappy, or otherwise disengaged. From dwindling creativity to more accidents on the job, these unhappy workers cost employers up to $550 billion a year.[5]

How to build resilience at work

Given the detrimental effects of productivity loss and chronic health conditions, employers may find significant benefits to building resilience in the workplace.

There are a variety of structural and policy-driven ways to approach this challenge, with robust employee wellness programming at the forefront. A RAND Corporation study uncovered an overall return of $1.50 for every dollar invested in an employee wellness program. When viewing the program by each component (disease management versus lifestyle management), it reported, “…the returns for the individual components differ strikingly: $3.80 for disease management but only $0.50 for lifestyle management for every dollar invested.”[6]

Empowering employee wellness

Encouraging positive lifestyle and disease management is important, but giving employees clear, actionable ways to do so is even more important.

Regularly tracking basic vital signs such as blood pressure, blood glucose, and weight can help employees develop a baseline understanding of their health. Over time, these measurements create a fuller picture, revealing trends and opportunities for improvement.

Similarly, tracking wellness activities, such as sleep quality, mood, and hydration can help employees feel a greater sense of engagement and ownership in their own health. Viewing wellness trends over time can help employees see the relationship between activities and outcomes, spurring on positive behavior changes.

Social support has been shown to contribute to resilience as well.[7] This support can come in many forms, including informational support such as guidance and mentoring.[8] Wellness programs that incorporate health coaching can provide the informational support employees need to improve their health outcomes. Health coaching provides employees an accountability partner and a safe place to explore strengths and motivations for a healthier lifestyle.

The importance of mental health has taken center stage during the pandemic. Wellness programs that include mood tracking and reminders to connect with friends and family can lead to increased emotional intelligence (the capacity to be aware of, control, and express emotions). When an employee has high emotional intelligence their communication skills, rational thought patterns, and ability to express and feel empathy are all increased. Feeling heard, understood, and connected in the workplace are critical for individual resilience.[9]

Which wellness program will you choose?

As an employer, the investment you make to support the physical and mental health of your employees can pay dividends. What are you doing to foster resiliency in your employees? Think beyond the basics. Forward-thinking organizations of all sizes are leveraging the current focus on health and healthcare to foster employee engagement and ownership of health.

When comparing wellness program options, consider finding a solution that includes the following elements:

  • Health literacy
  • Vitals measurements and tracking
  • Personalized health coaching
  • Activity tracking
  • Mindfulness tools
  • Wellness challenges

Show your employees that their well-being is paramount to the company’s success. Resilience in the workplace won’t happen overnight but offering an employee wellness program can be a step toward greater health and job satisfaction for the team.

[1] Belli, G. (October 1, 2018). Here’s how many years you’ll spend at work in your lifetime. Retrieved November 29, 2021, from https://www.payscale.com/career-news/2018/10/heres-how-many-years-youll-spend-work-in-your-lifetime.

[2] Beeler Asay, G., PhD, Roy, K., PhD, Lang, J., MPH, MS, Payne, R., MPH, & Howard, D., PhD. (October 6, 2016). Absenteeism and Employer Costs Associated With Chronic Diseases and Health Risk Factors in the US Workforce. Retrieved November 29, 2021, from https://www.cdc.gov/pcd/issues/2016/15_0503.htm

[3] Integrated Benefits Institute (December 8, 2020). Poor Health Costs US Employers $575 Billion and 1.5 Billion Days of Lost Productivity per Integrated Benefits Institute. Press release. Retrieved November 29, 2021, from https://www.ibiweb.org/poor-health-costs-us-employers-575-billion/.

[4] Cision PRWeb (May 21, 2012). Companies Lose One-Quarter of All New Hires, Survey Says. Press release. Retrieved November 29, 2021, from https://www.prweb.com/releases/2012/5/prweb9528745.htm.

[5] Clifford, C. (May 10, 2015). Unhappy Workers Cost the U.S. Up to $550 Billion a Year (Infographic). Entrepreneur. Retrieved November 29, 2021, from https://www.entrepreneur.com/article/246036.

[6] Mattke, S., et al. (January 9, 2014). Do workplace wellness programs save employers money? RAND. Retrieved November 29, 2021, from https://www.rand.org/pubs/research_briefs/RB9744.html.

[7] Cherry, K. (2021, April 24). How resilience helps when coping with challenges. Retrieved May 20, 2021, from https://www.verywellmind.com/what-is-resilience-2795059

[8] Cherry, K. (2020, April 14). How Social Support Contributes to Psychological Health. Retrieved May 20, 2021, from https://www.verywellmind.com/social-support-for-psychological-health-4119970

[9] Hayes, M., Chumney, F., & Buckingham, M. (2020). 10 Facts About Resilience: Executive Summary. Retrieved May 20, 2021, from https://www.adpri.org/wp-content/uploads/2020/09/03154031/R0121_0920_v1_RS_ExecSummary.pdf

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Data visualization for population health and chronic disease management

The cost and human suffering related to chronic diseases in the United States is staggering.

Hypertension (high blood pressure) costs the United States about $131 billion each year.[1] It is directly linked to heart disease and stroke–the two biggest killers each year combined.[2] Similarly, more than 34 million people in the United States have diabetes, and, of those, 90% to 95% have a type 2 diagnosis[3], which the Centers for Disease Control and Prevention (CDC) notes can be prevented or delayed through lifestyle changes.[4] It costs approximately $327 billion yearly to cover medical expenses and lost work and wages for this population.[5]

Considering that the CDC reports, “90% of the nation’s $3.8 trillion in annual health care expenditures can be attributed to those living with chronic disease,” it’s clear that to lower costs and improve health, we must focus on preventing and managing chronic disease.[6]

Using data visualization to manage chronic disease

Using data visualization is one of the simplest ways we can begin to improve the care and outcomes for populations living with chronic diseases. To understand this better, let’s look at hurricane forecasting as an analogy for preventing, or at least managing, chronic disease care.

Hurricane Dorian
Figure 1: Hurricane Dorian projection on August 29, 2019 [7]

Hurricane forecasts begin with collecting data. Satellites, radar, and other instruments are used to capture atmospheric conditions. As the hurricane develops, the information is then used to inform the public of potential risks, creating models to track the speed, intensity, and path the storm may take. Every day, every data point gives meteorologists the ability to tighten up their predictions right up to the event. By the time the storm makes landfall, the forecast has given residents enough warning to secure their homes and head toward safer ground.

The regular input and tracking of vital signs play a similar role to our weather analogy above. By taking daily blood pressure or blood sugar readings, individuals and their care providers can begin to visualize data, identifying trends and patterns. Even if a health “storm” cannot be entirely averted, the data may provide forewarning to mitigate the landfall of a stroke, heart attack, or the onset of type 2 diabetes.

To further illustrate the point, the chart in Figure 2 below displays an individual’s blood pressure readings over the course of a year (as tracked through the Milliman HealthIO app). The individual and their care provider might make several observations from this data visualization, including:

  • A steady increase in blood pressure over time, as indicated by the blue line
  • A recent downward trend in blood pressure, as indicated by the red line
  • An overall cyclical nature to the individual’s blood pressure readings, as viewed by the dot placements of each reading

Armed with this data, the individual and care provider can work together to craft an appropriate intervention, heading off a potential negative health event.

Figure 2: HealthIO system generated report for a de-identified individual in a client’s population, measuring blood pressure over time.

Putting it into practice

Milliman HealthIO’s work with a community health organization shows the power and promise of data visualization to manage at-risk populations. 

Individuals were given “smart” health devices to track their basic vital signs. A scale, blood pressure cuff, glucometer, and pulse oximeter synced both daily and weekly data points for each person in the program. Over time, the reports provided to the clinic identified opportunities for intervention among the individuals who showed elevated, out-of-range readings. The data visualization allowed the clinic’s medical staff to make informed decisions more quickly. The clinic followed up with its at-risk population, getting ahead of potential health crises and their associated costs.

In one example, a member of the community health organization began to monitor his blood pressure each day. He then added blood glucose measurements to the daily monitoring schedule. Both the member and his care manager noticed a trend of elevated blood pressures and blood glucose.

The member’s physician was notified and reviewed the vitals data, leading to a medication change for antihypertensives and adjustments to the member’s insulin and oral hypoglycemic treatment.

In another example, a member used the HealthIO devices and app to complete daily pulse oximeter measurements. The member’s data revealed a trend: in the early morning, she continued to have pulse oximeter levels less than 90%. Her physician was notified, further testing was completed, and the member began a treatment protocol with continuous oxygen during sleep.

In each case, longitudinal trend data enabled both members and the care team to catch problems early on and intervene before a more serious health event occurred.

Data visualization has a long history of helping decision makers take action across industries. For payers and health systems, these powerful, visual dashboards are helping drive action for vulnerable populations. For employers who have gotten a taste of population health management through the COVID-19 crisis, the opportunities to empower better health and manage financial risk may be a game changer. Partnering with a digital health provider can be a solid first step in using data visualization to predict, prevent, and manage chronic disease.

[1] CDC. Facts About Hypertension. Retrieved November 29, 2021, from https://www.cdc.gov/bloodpressure/facts.htm.

[2] CDC. Health and Economic Costs of Chronic Diseases. Retrieved November 29, 2021, from https://www.cdc.gov/chronicdisease/about/costs/index.htm.

[3] CDC. Diabetes Fast Facts. Retrieved November 29, 2021, from https://www.cdc.gov/diabetes/basics/quick-facts.html.

[4] CDC. Prevent Type 2 Diabetes. Retrieved November 29, 2021, from https://www.cdc.gov/diabetes/prevent-type-2/index.html.

[5]  CDC, Diabetes Fast Facts, op cit. 

[6]  CDC, Health and Economic Costs of Chronic Diseases, op cit. 

[7] National Center for Atmospheric Research (August 29, 2019). Hurricane Dorian (AL05). University Corporation for Atmospheric Research. Retrieved November 29, 2021, from http://hurricanes.ral.ucar.edu/realtime/plots/northatlantic/2019/al052019/track_early/aal05_2019082918_track_early.png.

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The role of data visualization in healthcare

“A picture is worth a thousand words.” We’ve all heard this old adage, but in the age of big data, it takes on new meaning. Few people have the gift of simply looking at numbers and gleaning useful information. Data visualization brings clarity to the numbers, statistics, and measurements that make up healthcare today.

What is data visualization?

Data visualization is a visual representation of information. Using graphs, charts, tables and other imagery, data visualization helps put meaning to data points. Most importantly, data visualization is a tool that helps a person analyze and make decisions. It helps to understand that data visualization is one step in a larger process of data analytics, as shown below.

data visualization pathway

The idea of data visualization isn’t new. We still use the Mercator Projection to represent the world map—an innovation that came on the scene in 1569.[1] Industries as diverse as finance and manufacturing make great use of visualization, through stock charts, income statements, productivity graphs, and more.

How is data visualization used in healthcare?

In healthcare, most people are familiar with simple data visualizations, such as a pediatric growth chart. Measurements are plotted at each visit, establishing a trend line over time. Providers use the chart to determine whether the child is growing at an expected rate in an established range. If the child falls significantly outside the acceptable range, the visualization helps the provider make decisions on treatment and care moving forward.

However, much in healthcare is not as simple or straightforward as a child’s growth over time. It has been reported that healthcare organizations have seen an 878% health data growth rate since 2016.[2] For this reason among many, data visualization has exploded in the healthcare industry. The use of infographics, dashboards, and other visual analytics can make complex datasets easier to understand and act upon. Visualizations are used in everything from government projections of healthcare costs to the simple activity tracker on a consumer’s smartphone.

Data visualization examples

Data visualization is most meaningful when it answers a question or prompts decision-making and action. Typical visualizations might include:

  • Comparisons (“How is my blood pressure today compared to yesterday?”)
  • Counts or amounts (“How many hours of sleep did I get last night?”)
  • Trends/patterns (“Each year during the holiday season I gain weight.”)

For visualizations on an individual level, such as those recorded in the HealthIO app, the data can help a user and his or her provider decide the best course of action for optimal health.

Sample HealthIO data visualization for blood pressure reading over time.

For visualizations used at a macro level with de-identified data, the data can help government agencies, provider groups, payers, or self-insured employers understand the health trends of their respective populations.

For example, the Centers for Disease Control and Prevention published its “National Diabetes Statistics Report 2020”, replete with a variety of charts and graphics. The data visualization revealed that, “Among US children and adolescents aged 10-19 years…overall incidence of type 2 diabetes significantly increased.”[3]

Source: Centers for Disease Control and Prevention. (2020). National Diabetes Statistics Report, 2020. U.S. Department of Health and Human Services.

Another approach is to combine visualization with additional analytical approaches like categorization to evaluate trends and distribution of risks across a population as seen within the HealthIO example below.

Example of an area chart showing categorized data generated from the HealthIO platform.

In this area chart, a client’s population is categorized by their risk of hypertension. Category one represents the lowest risk with each subsequent category indicating a higher level of risk. By category six, some individuals in this population will have already been diagnosed with hypertension and tasked to manage their condition.

Using this type of data visualization can help clients see fluctuations in their population’s risk over time. In this example, categories five and six (those at highest risk of developing or having hypertension) peaked around February 15th, 2021.  Although these highest risk categories declined over the next two weeks, the trend line appears to be increasing again. With such trends visualized and identified, decision-makers are equipped with the information needed to plan appropriate interventions for the at-risk population.

Potential pitfalls of data visualization

While data visualization can provide much needed clarity, caution should be exercised. Given the overabundance of data points, it is possible for a visualization to become overly complicated. Poorly designed graphics can be hard to interpret or analyze. Data visualization should always start from the viewpoint of answering a question. The type of answer sought will drive the design of the graphic and help overcome these challenges.[4]

The potential for errors in data is an additional concern. Using bad data to create a visualization could lead to incorrect trends or indicators. Bad data can include duplicate data, missing data or data that is incorrectly tabulated. While data is highly dependent on its source and the method used to record it, steps can be taken to mitigate the risk. Risk mitigation can include automating the data acquisition, cleansing data, running automated data quality tests, and utilizing human oversight to validate system results where possible. It’s just as important to trust the data processor as it is to trust the data source when evaluating data visualizations.

Will data visualization lead to better health outcomes?

The prevalence of big data has put more information into the hands of consumers and organizations than ever before. As data visualization continues to evolve and improve, adding storytelling to the data can help highlight the most important aspects of the graphic representation.[5] While data visualization is not a motivator on its own, the insights it reveals can be a step on the path to eventual behavior change.

[1]  Farnworth, R. (July 3, 2020). Towards data science. Retrieved March 18, 2021, from https://towardsdatascience.com/a-short-history-of-data-visualisation-de2f81ed0b23

[2] Donovan, F. (May 8, 2019). Organizations see 878% health data growth rate since 2016. Retrieved May 24, 2021, from https://hitinfrastructure.com/news/organizations-see-878-health-data-growth-rate-since-2016

[3] Centers for Disease Control and Prevention. (2020). National Diabetes Statistics Report, 2020. U.S. Department of Health and Human Services. Retrieved March 18, 2021, from https://www.cdc.gov/diabetes/library/features/diabetes-stat-report.html

[4] Durcevic, S. (May 2, 2019). Designing charts and graphs: How to choose the right data visualization Types. The datapine Blog. Retrieved March 18, 2021, from https://www.datapine.com/blog/how-to-choose-the-right-data-visualization-types/

[5] Meyer, M. (December 21, 2017). The rise of healthcare data visualization. Journal of AHIMA. Retrieved March 18, 2021, from https://journal.ahima.org/the-rise-of-healthcare-data-visualization/

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Rethinking the annual visit

Woman sitting on couch using digital health tools

How digital health can improve patient outcomes, one data point at a time

Woman sitting on couch using digital health tools

The norm of the annual visit

Maggie sits down in her sunken recliner, sets her venti caramel macchiato on the side table, and props up her feet. Using her smartphone, she rings her son Nathan. “I just got home from Dr. Garcia’s office, and he says that I have a clean bill of health. Tomorrow, I’ll be fully vaccinated so I’m ready to book a flight to meet my new grandbaby!”

But does Maggie really have a “clean bill of health”? As her primary care provider, that’s not exactly what you told her at her annual exam. During her annual exam, you had her vitals taken, updated her health records, and ordered a routine cholesterol screening. You noted that her blood pressure was a touch high but were unsure if that reading was due to your own presence as a doctor, also known as “white coat hypertension”[1]. Overall, Maggie’s annual didn’t inspire any serious health conversations, but you did remind her to watch her weight—according to her chart, she’s gained about five pounds a year over the past couple of visits. In an effort to educate her on the health benefits of regular movement, you printed out an easy exercise guide for her to take home.

It appears you and Maggie have different ideas of what a “clean bill of health” looks like. Once Maggie leaves your office, the best you can do is hope that she takes your professional advice. And it won’t be until next year that you’ll get a look at Maggie’s health vitals again—unless she has a health emergency in the meantime. Despite your best efforts, Maggie’s yearly appointment may not be impactful enough to prevent chronic disease. In fact, there is professional conversation on the rise about eliminating the annual visit altogether.[2]

Are annual visits effective?

During Maggie’s annual visit, she was flooded with numbers: weight, blood pressure, temperature, heart rate, etc. With this influx of information, it’s easy to imagine she was overwhelmed or even forgot what she was told and what her health data meant. Additionally, if Maggie is like most people, she tends to have an optimistic vision of her health.[3] As long as you didn’t have any threatening concerns, she can’t think of a reason to make a lifestyle change. See you next year, doc!

This thinking not only puts the weight of Maggie’s health on a once-a-year visit, but it also doesn’t empower or encourage her to establish strategic and routine healthy habits outside of your office. Put simply, annual visits may simply not be enough to drive positive health outcomes. Furthermore, many activities within the annual exam lack any evidence of benefit.[4] Harvard Medical School adds to the somewhat controversial discussion, saying that “being seen by your doctor once a year won’t necessarily keep you from getting sick, or even help you live longer. And some of the components of an annual visit may actually cause harm”.[5]

Against this backdrop, the push toward value-based care models continues to gain momentum. Though your medical practice hasn’t fully transitioned to value-based care, the leadership team has started moving in that direction by establishing three goals to improve population health:

  • Identify at-risk and rising-risk populations
  • Design effective interventions to prevent or mitigate chronic diseases like hypertension and diabetes
  • Reduce the number of unnecessary hospital admissions and 30-day readmissions

These goals introduce an interesting conundrum when practicing medicine under the traditional episodic model of care. Maggie is a responsible, reliable patient who schedules her annual physical each year. And yet, that annual visit may not be enough to prevent a serious chronic health event in her future. The limitations of the annual exam lie within its name—you will only collect data from Maggie annually. Without any updates on her vitals throughout the next year, you can only hope that she doesn’t dip into an at-risk population, develop a chronic disease, or take an otherwise avoidable trip to the ER.

From episodic care to continuous care

Let’s take a look at Maggie again. After wrapping up her annual exam, you were hopeful that she’d pay closer attention to her weight and her diet, along with adding some moderate exercise into her daily routine. Little do you know that immediately after leaving the appointment, Maggie hit the coffee shop on her way home and already has her feet up in the air. She also forgot to tell you during her visit that she had a torn retina last year, so her new sensitivity to light has her staying indoors a lot more. Even though you shared an exercise flyer with her, it’s already landed in the junk mail pile on the counter.

It’s clear that Maggie is living a largely sedentary lifestyle, and it’s proven that an inactive lifestyle is a risk factor for hypertension, which can lead to chronic illnesses like heart disease, kidney disease, and strokes.[6] But it doesn’t stop there. With less movement, and an existing weight gain trend, Maggie is also at risk for diabetes. Of course, those sugary coffee drinks don’t help.

As a medical professional, you know that chronic illnesses can often be prevented, but it’s difficult to prevent something if there are no visible warning signs and limited engagement with your patient. Remember, Maggie thinks she received your stamp of approval. By the time you see Maggie again, she may already have hypertension or be prediabetic.

Obviously, there’s a problem. The traditional, episodic model of care fixes problems after they occur: Maggie feels sick, so she makes an appointment to see you. Under this model of care, it’s expensive and unrealistic to see Maggie more than once a year for a physical. How can you keep Maggie on track with her health goals in between visits?

Using digital health alongside annual visits

It’s trendy to be healthy. One in five people use a fitness tracker,[7] and some studies show that people of all generations are willing to pay more for healthier food options.[8] With people actively seeking out ways to improve their health, eliminating annual visits altogether is unnecessary, especially since 54% of US adults make a trip to their primary care doctor at least once a year anyway.[9]

It might be the right time to consider how a digital health strategy can complement your patient’s annual wellness check. Incorporating digital health tools can empower Maggie to take ownership of her health by tracking and monitoring simple vital signs. Better yet, if Maggie uses a digital health tool, you and the rest of her care team could have access to her near-real-time and trending health data—not just the single, yearly snapshot you usually view. With that access to data through remote patient monitoring, you’d have the insight and the ability to intervene promptly if Maggie began developing any negative health issues.

A holistic, data-driven view of Maggie’s health can lead to valuable, actionable insights on the prevention (or management) of chronic conditions. For instance, if Maggie measures and records her blood pressure consistently at home, the emerging trend data can tell you both if she’s at risk of developing hypertension. And if your entire patient population was similarly empowered to track and share their health trend data with you on a regular basis, you’d be taking meaningful steps to achieve the shift from volume to value outlined by your management team too.

The benefits to longitudinal data

If Maggie monitors her health at home, it can help you manage and mitigate her risk for diabetes and hypertension. However, implementing a digital health platform can lead to a multitude of other gains too, such as:

  • Reducing healthcare expenses by decreasing nonessential tests/labs[10]
  • Supporting patient lifestyles that practice preventive versus episodic care
  • Focusing specialized care to at-risk populations through data and analytics
  • Encouraging patients to set up a support system of all their providers to keep them on track
  • Empowering patients to take ownership of their own health—both behaviors and outcomes
  • Reducing unnecessary ER admissions and readmissions

Prevention is just one path to lowering healthcare costs. Studies have also shown that patients who already live with a chronic disease can use digital health to manage their condition.[11] From a population standpoint, there will inevitably be patients with chronic conditions, too.

Maggie is a self-starter and cares about her health. She’s proud to say she has an annual exam every year. But Maggie can’t effectively manage her health from data captured just once a year—and neither can you. It’s time to reimagine the annual visit. Using a digital health approach, you can enable Maggie and all your patients to regularly track their vitals—providing meaningful, actionable longitudinal data to discuss during an annual physical. That could be a game changer for their health—and for the business of healthcare too.

[1] 2 Minute Read Medically Reviewed by Heart and Vascular Institute June 22, 2. (2018, August 29). Is white coat hypertension real? Retrieved September 15, 2021, from https://share.upmc.com/2017/06/is-white-coat-hypertension-real/

[2] Mehrotra, A., & Prochazka, A. (2015). Improving Value in Health Care — Against the Annual Physical. New England Journal of Medicine, 373(16), 1485-1487. doi:10.1056/nejmp1507485

[3] David B. Feldman Ph.D. (2019 February) Is Optimism Ever Unhealthy? From https://www.psychologytoday.com/us/blog/supersurvivors/201902/is-optimism-ever-unhealthy

[4] Horn, D. M., MD, & Haas, J. S., MD. (1970, October 21). Covid-19 and the mandate to Redefine Preventive Care: Nejm. Retrieved October 27, 2021, from https://www.nejm.org/doi/full/10.1056/NEJMp2018749

[5] Amy Ship, M. (2015, October 23). A checkup for the checkup: Do you really need a yearly physical? Retrieved July 08, 2021, from https://www.health.harvard.edu/blog/a-checkup-for-the-checkup-do-you-really-need-a-yearly-physical-201510238473

[6] High blood pressure (hypertension). (2021, July 01). Retrieved July 15, 2021, from https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410

[7] Vogels, E. (2020, August 14). About one-in-five Americans use a smart watch or fitness tracker. Retrieved July 14, 2021, from https://www.pewresearch.org/fact-tank/2020/01/09/about-one-in-five-americans-use-a-smart-watch-or-fitness-tracker/

[8] Gagliardi, N. (2015, February 20). Consumers want healthy foods–and will pay more for them. Retrieved July 14, 2021, from https://www.forbes.com/sites/nancygagliardi/2015/02/18/consumers-want-healthy-foods-and-will-pay-more-for-them/?sh=403bdeff75c5

[9] Artandi, M., & Russell, S. (2020, June 18). Telemedicine paradoxically deepened our connections with patients. Retrieved July 08, 2021, from https://www.aamc.org/news-insights/telemedicine-paradoxically-deepened-our-connections-patients

[10] Dorsey, E. R., & Topol, E. J. (2020). Telemedicine 2020 and the next decade. The Lancet, 395(10227), 859. doi:10.1016/s0140-6736(20)30424-4

[11] How digital health care can help prevent chronic diseases like diabetes. (2020, October 29). Retrieved July 08, 2021, from https://hbr.org/2017/11/how-digital-health-care-can-help-prevent-chronic-diseases-like-diabetes

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HLTH 2021

We’re Boston-bound!

By Sara Aldworth |

The Milliman HealthIO team is excited to sponsor HLTH 2021, the industry’s most important event for healthcare innovation.

We invite you to join us for a 10-minute Tech Talk on Monday, October 18th at 4:05 p.m. EDT. Our CTO Dave Neuman will be appearing on stage in Hall A, explaining how digital health can help us see the forest AND the trees.

Of course, you don’t have to wait until HLTH to meet us—our door is always open. Drop us a note and let’s connect. We’d love to help you solve your toughest healthcare challenges.

Want to learn more about us? Check out our HLTH Announcement Spotlight below for preview of what we do.

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Milliman HealthIO launches next-generation digital health platform, with enhanced capabilities to prevent and manage chronic conditions

Newest release builds on Milliman’s analytics and advanced intelligence with mobile-first platform to track and monitor health vitals for the prediction and prevention of chronic diseases

SEATTLE – AUGUST 10, 2021 – Milliman, Inc., a premier global consulting and actuarial firm, announced today that Milliman HealthIO launched its next-generation digital health platform, combining Milliman’s state-of-the-art predictive health analytics and HealthIO’s preventive health technology.

HealthIO (acquired by Milliman, Inc. in June 2020) provides a mobile-first app-based platform, enabling users to capture and record multiple health vitals on a regular basis. The resulting longitudinal data is easy to share with healthcare providers and reveals valuable insights into an end-user’s health status during the many hours they spend away from the healthcare system.

With a focus on data visualization, this next-generation release features an entirely redesigned consumer-friendly app, streamlining the end-user experience. Client dashboards reveal a risk-stratified, population-level view of health, enabling self-insured employers, health plans, life insurers, and capitated healthcare providers to make informed decisions on how to best manage their health risks and choose timely interventions to drive better health outcomes.

“Our mission has always been centered on enabling a predictive, preventive, and empowering approach to health,” said Sanjay Mohan, Managing Director of Milliman HealthIO. “Our first post-acquisition release is an exciting milestone, culminating in a digital health platform that offers actionable and sophisticated data-driven insights to our clients and end-users. We feel confident that our second-generation platform will deliver significant value for those looking to tackle the high costs associated with chronic disease.”

Milliman Principal Brian Studebaker added, “Over the past year, the pandemic has demonstrated the benefit, and perhaps even the necessity, of using digital health to bridge gaps in care and information. The next-generation HealthIO platform is perfectly situated to help provide that “missing” health data, captured on a regular basis by HealthIO end-users. We’re excited that our predictive analytics and insights will be used by individuals, care providers, and customers across the healthcare industry to drive better health and financial outcomes.”

For more information, visit https://www.healthio.milliman.com

About Milliman

Milliman is among the world’s largest providers of actuarial and related products and services. The firm has consulting practices in healthcare, property & casualty insurance, life insurance and financial services, and employee benefits. Founded in 1947, Milliman is an independent firm with offices in major cities around the globe.  For further information, visit milliman.com.

About Milliman HealthIO

Milliman HealthIO is a business-to-business-to-consumer digital health company serving self-insured employer groups, health plans, life insurers, and capitated healthcare providers. Its platform uses predictive analytics and advanced algorithms to identify and stratify population-level risk for clients and generate timely and personalized insights for end-users. For further information, visit healthio.milliman.com.

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